More Income for You, as New Codes Cover Video Patient Visits, Virtual Check-in, Remote Monitoring

Betsy Nicoletti, MS

Disclosures

February 18, 2019

In This Article

Virtual Check-In -- Over the Phone

In 2019, CMS developed two new HCPCS codes that describe non–face-to-face covered services.

The bad news first. Both have low work RVUs (wRVUs) and payment. Both require verbal consent to bill, and are subject to coinsurance and deductible. They are HCPCS codes, and there is no guarantee that other payers will reimburse them.

The first new code is for a virtual check-in (Table 1), and the second is for reviewing an image or recording, or "store and forward" (Table 2). CMS said it does not consider these to be telehealth services, although they are "technology-based" and so they do not need to meet the requirements of telehealth, as described above.

Is there good news? We said, "The bad news first." Where is the good news?

Table 1. HCPCS Code G2012: Brief Communication Technology-Based Virtual Check-In

HCPCS Code Description wRVUs Total Nonfacility RVUs National Nonfacility Fee Amount
G2012 Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified healthcare professional who can report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 0.25 0.41 $14.78

E/M = evaluation & management; HCPCS = Healthcare Common Procedure Coding System; RVU = relative value unit; wRVU = work relative value unit

Physicians Already Have the Technology

Physicians already have technology in their office that can facilitate better technology-based check-ins. In fact, they have been using it for years: It's the telephone.

The 2019 Physician Fee Schedule Final Rule says:

We are persuaded by the comments advising us not to be overly prescriptive about the technology that is used, and are finalizing allowing audio-only real-time telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission. We note that telephone calls that involve only clinical staff could not be billed using HCPCS code G2012 since the code explicitly describes (and requires) direct interaction between the patient and the billing practitioner.

The service could also be performed using more advanced technology, such as a patient portal or a Health Insurance Portability and Accountability Act- compliant video service.

This code is used when the check-in does not result from a related E/M service within the past 7 days, or result in a service in the next 24 hours, or the next available appointment. It is for a brief, non–face-to-face service provided by a physician or nonphysician practitioner, not a staff member. It may be used only for established patients.

The provider must have E/M in their scope of practice, so social workers and other types of therapists may not use it. It is used to determine whether an appointment is needed. If the call is a follow-up from a prior E/M service or if a visit is necessary and provided, the practice may not bill for this virtual check-in.

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